There’s nothing like a good night’s sleep. That refreshed feeling where you’re ready for your day and are able to tackle your to do list with ease is priceless.
But man, when sleep is elusive or fickle, it can be devastating. You’re exhausted, but your body just won’t cooperate when it’s time for bed. No wonder they use sleep deprivation as a form of torture!
Unfortunately, insomnia occurs more frequently in perimenopause which can exacerbate already problematic perimenopause symptoms like brain fog, fatigue, weight gain, and more.
While there are medications available for insomnia, most of them are not without side effects and aren’t intended for long-term use. And as they do nothing to address the root cause of the insomnia, if you discontinue them, you’re back to square one of not sleeping.
Luckily, we have numerous natural options for improving sleep in perimenopause. But first, it helps to know what kind of insomnia you have. Insomnia which falls into 3 main categories: the inability to initially fall asleep, waking up throughout the night, waking up too early, or any combination of the above. In addition, the sleep disturbance must occur at least three times a week for at least a month to be considered true insomnia.
While some of the recommendations here will help improve sleep quality overall, there are a few treatments that are only appropriate for those who have difficulty falling asleep and not staying asleep, or vice versa.
Get Back To Basics
For whatever reason, we think once we reach adulthood, what was true when we were younger no longer applies just because we are now an adult. Perhaps it’s the freedom of no longer having someone controlling when you go to bed that results in our staying up too late or watching TV in bed.
Proper sleep hygiene, simple as it may be, can have a profound impact on sleep. Our bodies generally thrive on having a routine so if you’ve gotten away from a nighttime routine, it’s time to revisit it. You are essentially signaling to your brain that it’s time to start slowing down in anticipation of blissful slumber.
There are many articles and books written about sleep hygiene, but some great starting points include limiting screen time, especially an hour before bed time and replacing it with a relaxing epsom salt bath, reading a physical book, a gentle stretching routine, or a brief meditation or breathing practice.
Another often overlooked sleep hygiene tip is to consider the environment that you’re sleeping in. Is your bedroom cluttered and overwhelming? Does it serve a dual purpose as an office or workout room? Do your pets sleep in bed with you? Do all you can to remove any stimulation from the bedroom, so it is a calm and peaceful space.
But don’t forget about the morning too. Light is the number one influence on melatonin production so what research has found is that if you expose yourself to light in the morning, that can help reset your circadian rhythm, possibly resulting in better sleep at night. Take a few minutes in the morning to go outside in direct sunlight (if available) without glasses or contacts for maximum exposure.
Stay Cool
A common reason women in perimenopause have disrupted sleep is due to becoming overheated and battling night sweats. Night sweats are hot flashes that occur at night and if they are frequent enough, can be disruptive to a good night’s sleep.
While hot flashes will be covered more depth in a future article, there are a few things you can try to stay cool throughout the night.
It may sound simple but keep your bedroom at a cooler temperature. My partner and I have our thermostat set lower in the bedroom than the main living part of the house to keep the bedroom cooler at night. Consider wearing lighter clothing (or nothing) to help prevent overheating. And a strategically placed fan can make a world of difference to keep you cool while you sleep.
Other options include a tepid or cooler shower at night, or you can try drinking a tea of cooling herbs like sage and lavender before bed. Alternatively, the sage tea can be made into a spray that can be used to cool your body down.
Nutrition Strategies for Sleep
We’ve discussed previously the role melatonin (link) plays in sleep but there are nutritional considerations for supporting optimal melatonin production. To start, getting enough protein is crucial so we can have adequate levels of tryptophan, the precursor to melatonin.
In addition, B vitamins, zinc, and magnesium help convert tryptophan ultimately to melatonin, so it’s important to make sure that you have the nutrients needed for your body to actually produce melatonin. Then, if needed, you can always use a supplement.
There also are some foods that have melatonin in them. Studies have found that tomatoes, walnuts, strawberries, rice, olive oil, and milk (cow) have enough melatonin to have an impact on sleep. It seems that tradition of giving a child warm milk before bed actually has some scientific merit.
Now on the other hand, there are foods that can disrupt sleep, mainly coffee and alcohol. Coffee and alcohol appear to reduce the production of melatonin in the blood, thereby affecting sleep. We also know that blood sugar imbalances can disrupt, especially waking throughout the night so keeping refined sugars to a minimum is important for sleep.
Botanical Medicine Favorites
I would be remiss to discuss strategies for sleep without talking about herbs. Herbs are generally safe, effective, and can help restore or reset your system. This means when you discontinue, you’re in a better place.
For Initiating Sleep:
One great herb for sleep is Passionflower (Passiflora incarnata). Passionflower is a mild sedative, and it helps with anxiety. If you can’t quiet your mind at night due to anxiety or have a feeling of “wired and tired”, Passionflower may be able to help. It’s generally safe but should be avoided in pregnancy. A typical dose is anywhere from a quarter up to a full teaspoon of the tincture three times a day. The tincture itself is quite bitter so the glycerite form is a more palatable option.
Another wonderful herb for sleep is American Skullcap (Scutellaria lateriflora). Like Passionflower, it helps to induce sleep be being mildly sedating. If you have anxiety but feel it physically through restlessness and muscle tension or spasms, American Skullcap can be really helpful. It works in the short term, so for acute situations (like you are moving or have a big life event coming up), or for long term support. This is a generally safe herb and the dosage ranges from a half teaspoon to a full teaspoon one to three times a day.
For Staying Asleep:
If staying asleep is more of your issue, one herb that I like to try that has recently become more popular is Ashwagandha (Withania somnifera). Ashwaganda (Ah-sh-wa-gan-da) is in general, a relaxing herb that helps with maintaining sleep and getting more restful sleep over time. While it is generally safe there are some safety concerns because it is a nightshade and a source of iron. The dosage is half teaspoon to a full teaspoon of tincture three times a day.
Another fabulous herb for staying asleep is Avena (Avena sativa), also known as Milky Oat. Like Passionflower, it’s good for those who feel “wired and tired” (though it’s much more palatable). With Avena, it is important to use the seed and not the straw as they have different actions. Avena is generally safe, and the dosing is a half teaspoon to a full teaspoon three times a day.
If you really need strong sleep support, we have California poppy (Eschscholzia californica). This herb is a strong sedative, so I usually reserve it if none of the other herbs have helped. While it will help induce sleep, it can also prolong sleep time. Because of its strengths, it should be avoided in pregnancy or if you’re on a CNS depressant or benzodiazepine. Due to its strength, I usually start patients out with an eighth of a teaspoon and gradually increase up to a full teaspoon of tincture if needed, about an hour before bed.
As with all herbs and recommendations, always check with your doctor first.
This is just the tip of the iceberg when it comes to natural options for sleep issues during perimenopause and what I’ve found works most often. As I mentioned earlier, we’ll dive more into tools for hot flashes and night sweats in the future if that is a large factor in your sleep disturbance. But rest assured that typically implementing even just one or two of the key strategies discussed can have a profound impact on sleep.